labor and delivery dilemna

[susan13]

ok, i am 34 week pregnant with twin and went to see my ob/gyn tonight and we talked about labor and delivery. last
week both babies were head down, now only one is. Well, it is my ob/gyn/midwife
policy that they fully support vaginal births for twins unless of course the
babies are in distres.

if all goes well, they will deliver the first vaginally and then try to turn the
second or do a breech birth depending on how the baby is progresing.

the problem is if the 2nd is not doing well and we have to do a c-ection. i was
planning on no drugs, but if have to do a c-section and i have not chosen to do
an epidural, it will be too late and i will have to be put under.

i really do not want an epidural, but at the same time i don't want to be put
under- ugh.

Any thoughts on what i should do?
i am really hoping we can get two vaginal births, but this is so much out of our
control, expecially if the baby does not turn again.

[nudnik]

I'd take that risk. Once the first is born, you're all stretched out, minimizing the risks of a breech. Chances that a baby will go into distress aren't all that great. Why give yourself a 100% chance of a drugged birth (and the cascade of interventions that is possible) because of the 5% (OK I made that up) chance of needing a C-section for the second twin?

[LoisLane]

My OB also told me that if Twin B was *truly* in distress, and even if I had had an epidural (or a port or whatever placed to be ready to do one), in a true emergency there wouldn't be enough time to boost it enough to do the section, so they would have to do a general anesthetic anyway.

Just something to consider...

[MamaChicken]

I declined the just in case epi. I don't think it would be any less or more traumatic in the case of a true emergency. Worked out well for me with a great epi-free hospital birth.

[DeerMother]

Seems I read that the second will often turn after the first is born.

[Molliejo]

Originally Posted by DeerMother

Seems I read that the second will often turn after the first is born.

Yes to this. And do not give up hope on your baby b turning again in late pregnancy, either. My baby b was head up at 36 weeks and head down at 38, something that both my midwife and ob told me would not happen (and she was big, too).

Good luck, mama!

[ShanaV]

I also struggled with this question my entire pg, for the same reasons as you. The good news is that you don't have to make the decision until the last moment! In my case, I had been in labor (PTL) for like 23 hours when I finally decided to take the just-in-case epi. The boys were born one hour later. Natural birth with the risk of general anesthesia seemed to me to be high risk high reward. Taking an epi seemed low risk moderate reward. For me, I'm just not a risk taker, so i did what I did. As it turned out, twin b slid right out after a, and I could have done it naturally. But such is life. I didn't want to take the risk.

[MamaChicken]

I should add that baby A was head down for a long time, flipped breech at 35 weeks, vertex two days later and stayed that way. Baby B flopped between breech and transverse the whole time, but slid down vertex after his bro came out. I talked to all my babies, telling them how it would be easiest if they come out head first. I talked a lot to them during my pregnancy, whole conversations while commuting. I figured if they would do their part, I would do mine!

[OGirlieMama]

I took the just in case epi and it paid off as twin A was born vaginally but twin B was in a bad position (jacknife) and started having decels, and thus was born a medically-necessary but non-emergency c-section. They were premature, 29 weeks, which surely made the decision more clear-cut (it's not like I was having some idyllic non-medicalized water birth no matter what) but it worked out as best as it could for me.

[2+twins]

I'm wondering why exactly there won't be time for an epidural after the birth of baby A if baby b doesn't rotate nicely? Being breech or transverse does not mean the baby is in distress? My baby b was transverse for a couple of hours before he turned on his own and was born head first. I understand that *sometimes* a baby might be in distress due to position but I wouldn't count on that. I'd much rather take the chance that everything will be fine, as it more than likely will be.

[f&p'smama]

I had a C-section with my twins due to Twin A being transverse breech, but had a VBAC with my singleton. They suggest an epi for similar reasons with a VBAC. I had a natural birth and refused an epi for the just-in-case emergency. If it's truly an emergency, you're probably going under even with the epi as they don't provide the total numbness of a spinal. If it's not an emergency, they can get the spinal in. It doesn't take that long.

Personally, I'd go into it visualizing the birth you want and planning for that and have back-up plans if you need them.

Good luck mama! Sending head down vibes to baby B!

[hotmamacita]

Are you open to swimming to try to get the baby to turn?

There is also a chiropractic technique called the Webster method that may help. Be sure to find a chiropractor who has experience with it.

My twins were both born breech @ 40 weeks 2 days. At the beginning of the 3rd trimester, we researched and invited care providers who were comfortable in catching breech twins. I am glad we did because I ended up with frank and footling breech babies, respectively. I swam and visited a chiro who the Webster technique but ultimately they turned back to breech at the end.

I think you have to be well-researched and comfortable with your care providers/setting because ultimately we do not know what birth has in store for us. I was not comfortable in a hospital setting and if I had been birthing at the local hospital, the breech twin situation could have gone really bad for the babies and us given the hospitals regulations and procedures.


Hope this helps.

[mauri456]

im coming up on delivery time too. baby a is vertex. baby b is all sorts of things. i think right now b is vertex but that changes minute to minute!! i am shocked that the kiddo can still move around in there.

what it has given me confidence in is that the baby will have plenty of room after a is born to turn. my ob/mw are okay with natural birth of twins. i am also a vbac. i have told them that i dont want an epidural, however, i acknowledge that we cant predict things so if it is a needed tool to assist with delivery i will be open to discussing one....

what i mean by that mainly is if it is a super long labor or if the baby wont drop or if there is some distress and an epi will give me more time bc they wont be worrying about that aspect. i do feel confident in myself and that i can birth my babies without one -- however -- i feel like i trust my providers too and will work with them.

it does help that my mw does homebirths and the ob that backs her is my ob. he has about a 10% c/s rate and very much believes in natural birth.

[hotmamacita]

Originally Posted by mauri456

\
it does help that my mw does homebirths and the ob that backs her is my ob. he has about a 10% c/s rate and very much believes in natural birth.

You are so fortunate!!!!! That is wonderful.

[budwana birth]

Originally Posted by 2+twins

I'm wondering why exactly there won't be time for an epidural after the birth of baby A if baby b doesn't rotate nicely? Being breech or transverse does not mean the baby is in distress? My baby b was transverse for a couple of hours before he turned on his own and was born head first. I understand that *sometimes* a baby might be in distress due to position but I wouldn't count on that. I'd much rather take the chance that everything will be fine, as it more than likely will be.

I just had this conversation with my OB she said in most cases, there'd be time for a spinal, and that it would only be in a severe emergency that the need for general anesthesia would be warranted. It may depend on your hospital and the availability of the anesthesiologist.

[Dena]

I also was fortunate enough to have an OB who very much supported natural birth (enough to even hand pick my very crunchy l & d nurse for me the day of delivery). In my case, baby A went head down and engaged early on, and baby b, also known as Princess Maya Troublemaker, flipped back and forth several times, ending up transverse with her head at my hip at the time of delivery. After calling her a stinker, my OB did a quick and easy external version and had the nurse and intern hold her in place while he broke her water. She stayed head down and out she came a few minutes later. As the pps have said, you are pretty stretched out, and there is a lot of room to flip a baby after the first is out. Not the most comfortable procedure, but a heck of a lot better than c-section recovery, imo.

When discussing this before the birth, my OB was fine with me declining the "just in case" epi. I don't believe there was even a discussion about general anesthesia for the second, unless of course there was a true emergency. What I was told was that as long as baby a was head down, we were good to go, and that he would even reach inside and turn baby b if he had to, and that he had had good luck doing that. He cautioned me that sometimes the baby doesn't stay turned and I might end up with the "total birth experience," but that was a risk I was willing to take. As it was, it was a pretty quick and easy vag. birth, no drugs, not even a hep lock in my arm. The only intervention I had was that the OB broke my water. Two hours later, both girls were out, and I was thinking, thank God I never have to do that again.

[smeep]

Didn't read the replies so I don't know if this has been mentioned, but I would be concerned about the epidural increasing your chance of a cesarean in the first place. It causes so many problems, especially since it reduces mobility (and leaves most women unable to move around at all) and therefore increases the chance of your first one even coming out vaginally, as well as the second one turning or being in a good breech position. It also adds stress to them, increasing the likelihood of distress, and can slow down labour which can lead to pitocin, which can cause so many issues. IMO, I'd rather take the small chance of having to be put under, as bad as that is, than increase the risk of needing a cesarean altogether. Epidurals also make them much more drowsy after birth which can seriously affect breastfeeding which you really don't need with twins, particularly if they aren't term yet (babies who aren't term yet, even those who are late preterm, often have suck/latch issues because they're just not yet developed enough neurologically).